Coronary endarterectomy for the diffusely diseased coronary artery

The diffusely diseased coronary artery is challenging for cardiac surgeons because diffuse atheromatous lesions frequently render it unsuitable for conventional distal grafting. Coronary endarterectomy was introduced in the 1950s as a treatment option for diffusely diseased coronary arteries. However, initial studies demonstrated high operative mortality and morbidity associated with coronary endarterectomy; therefore, many cardiac surgeons have been reluctant to perform this procedure. With percutaneous coronary interventions increasingly being applied to coronary artery disease, the incidence of complex and diffuse coronary artery disease in patients referred for coronary artery bypass surgery has been increasing, and recent advances in the surgical technique and perioperative management have improved the surgical outcomes of coronary endarterectomy. In this review article, we sought to discuss coronary endarterectomy for the diffusely diseased coronary artery.